He
then presents data from a Danish case-control study showing a strong
association between testicular cancer, low fertility and an excess
of females compared to males among offspring.

Observing
the link between these syndromes and previously documented links
between testicular cancer, low sperm counts and testicular abnormalities
(Berthelsen
and Skakkebæk 1983, Petersen
et al. 1998), Møller concludes by suggesting that
"decreasing sex-ratios in populations may be part of a scenario
of increasing male reproductive hazards, possibly also comprising
testicular cancer, male genital malformations and declining sperm
quality. The specific agents that may have caused the observed trends
remain to be identified, but agents that act prenatally to disrupt
normal development and differentiation of the male reproductive
organs may be particularly relevant."

Sex
ratio decline: Møller shows that the sex ratio among live
born infants in Denmark, Finland, Norway and Sweden has declined
significantly since 1945. The change is very small in absolute terms,
and according to Møller lacks any practical significance.
It is, however, quite significant statistically and the fact that
the trend is quite similar among these four countries, which maintain
indepedent data sets, adds additional strength to the observation.

adapted
from Møller 1998

Møller's
analysis of testicular cancer reveals large and significant increases
in the rate since the establishment of cancer registers in 1960.
All countries increased. The rate in Denmark is four times that
in Finland.

There
is strong evidence showing that this change through time is related
to birth cohort, implicating an event in the womb as the causal
agent
(Møller
1993, Møller
et al. 1996, Ekbom
and Akre 1998 ). According
to Møller, "current hypotheses link testicular cancer
risk to exposure of the male embryo to maternal or environmental
estrogens."

Møller
links testicular cancer, male infertility and altered sex ratio
through a case-control study in which men diagnosed previously with
testicular cancer are interviewed and compared with randomly selected
controls. The study examined a large number of risk factors.

adapted
from Møller 1998

This
graph illustrates the number of children born to men diagnosed with
testicular cancer up to two years prior to the TC diagnoses. Møller
took this approach to avoid having fertility influenced directly
by symptomatic disease or by treatment. As shown in the graph, "the
age-specific cumulative fertilities of men who later developed testicular
cancer were lower than in the controls, and the difference became
progressively larger with increasing age."

According
to Møller, "over a lifetime, the difference between cases
and controls amounted to about 0.5 child on average, independently
of any additional difference due to clinical disease or to its treatment.
This is a large difference" (emphasis added).

Finally,
Møller examines the sex ratio of offspring born to men who
subsequently developed testicular cancer. "Among the children
of the 514 testicular cancer cases, there were 252 boys and 288 girls,
i.e., a sex-ratio of 47%." This observed sex-ratio differs significantly
(p=0.03) from that expected on the basis of the population average
(51.4%) and approaches statistical significance compared to the control
population average (52%; p=0.06).